Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Erika Carter

Gonzales,LA

Summary

Managed Care Contracting Specialist with 17 years of experience, adept at team leadership, strategic planning, and healthcare policies. Demonstrates expertise in medical billing, coding, and electronic medical record charting. Committed to leveraging skills in managed care contracting to drive innovative healthcare solutions and improve system efficiencies.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Managed Care Contracting Specialist

Refresh Mental Health
08.2022 - Current
  • Coordinated 50+ contract processing activities monthly, ensuring 100% timely execution and compliance with regulatory standards
  • Maintained the contract management system, validating $5M in revenue and accounts receivable valuations with 99% accuracy
  • Interpreted and implemented managed care contracts, achieving a 98% accuracy rate in contract execution
  • Reconciled 200+ processed claims to the EHR daily, ensuring 100% data integrity
  • Managed data for 10 new acquisitions, enhancing operational efficiency and reducing processing time by 25%
  • Optimized the contract management system, improving claims reconciliation efficiency by 30% and increasing accuracy in accounts receivable valuations by 20%

Senior Care Connector

AmeriHealth Caritas Louisiana
01.2019 - 08.2022
  • Managed the distribution of daily work assignments, including worklist activities and fax queue management, ensuring timely completion and adherence to operational standards
  • Compiled and analyzed reports for Performance Outcome Measures campaigns, manual outreach initiatives, and Healthcare Effectiveness Data and Information Set collection, contributing to data-driven decision-making for monthly departmental meetings
  • Oversaw workforce management by adjusting schedules for optimal team performance and maintaining accurate records of attendance, paid time off, and leave requests
  • Conducted quality assurance by auditing team member calls, providing constructive feedback, and coaching, enhancing customer service standards and team competency

UM Technician

AmeriHealth Caritas Louisiana
03.2015 - 01.2019
  • Processed medical authorizations efficiently, ensuring timely and accurate decisions for those not requiring clinical review
  • Delivered comprehensive support to healthcare providers, addressing inquiries and facilitating the authorization submission process
  • Enhanced team capabilities by training new staff members and participating in the selection process for prospective employees

Account Advisor I

Capital Staffing/BCBSLA
08.2014 - 11.2014
  • Advised 200+ members on health plans and coverage, addressing inquiries and providing clear information with a 95% satisfaction rate
  • Educated 150+ members on benefits and coverage, enhancing their understanding and increasing member satisfaction by 20%
  • Assisted 50+ providers with member eligibility and benefits, ensuring accurate authorization processes with a 98% accuracy rate
  • Offered claims assistance, resolving 100+ issues for both members and providers efficiently, achieving a 90% resolution rate
  • Supported additional tasks, contributing to overall team effectiveness and improving member satisfaction scores by 15%

Member Services Representative

Centene Corporation
10.2012 - 02.2014
  • Advised members on insurance health plans across multiple states, ensuring accurate information
  • Educated members on health plan benefits and coverage, enhancing understanding and satisfaction
  • Assisted providers with member eligibility and benefits, facilitating smooth operations
  • Resolved claims issues for both members and providers, improving service efficiency
  • Updated member contact information, maintaining accurate records and communication

Customer Service Problem & Resolution Specialist II

Convergys
03.2006 - 05.2012
  • Resolved customer inquiries regarding mobile phone billing, ensuring clarity and satisfaction with services provided
  • Conducted training sessions for both new hires and existing staff on product updates and service offerings, facilitating consistent knowledge across the team
  • Supported the successful implementation of new business lines and pilot programs, contributing to seamless rollouts and enhanced service capabilities

Education

Master's - Healthcare Administration

Southern New Hampshire University
Manchester, NH
08.2021

Bachelor's - Business Administration

Southern New Hampshire University
Manchester, NH
05.2018

Skills

  • Team Leadership
  • Administrative Support
  • Strategic Planning
  • Research & Development
  • Microsoft Office
  • Tableau
  • Facets
  • Medical Billing & Coding
  • Medical Terminology
  • Electronic Medical Record Charting
  • Jiva
  • Healthcare Policies and Proposals
  • Innovative Problem Solver
  • Teamwork
  • Effective Communication
  • Active Listening

Certification

  • SHRM Certification
  • AHIMA Certification

Timeline

Managed Care Contracting Specialist

Refresh Mental Health
08.2022 - Current

Senior Care Connector

AmeriHealth Caritas Louisiana
01.2019 - 08.2022

UM Technician

AmeriHealth Caritas Louisiana
03.2015 - 01.2019

Account Advisor I

Capital Staffing/BCBSLA
08.2014 - 11.2014

Member Services Representative

Centene Corporation
10.2012 - 02.2014

Customer Service Problem & Resolution Specialist II

Convergys
03.2006 - 05.2012

Master's - Healthcare Administration

Southern New Hampshire University

Bachelor's - Business Administration

Southern New Hampshire University
  • SHRM Certification
  • AHIMA Certification
Erika Carter